Medicare Fraud Detection and Deterrence Act of 2025
Sponsored By: Representative Doggett
Introduced
Summary
Strengthen Medicare fraud detection and deterrence. This bill would require deactivation of the National Provider Identifier (NPI) for providers excluded for fraud and tighten provider ID rules in Medicare Advantage and telehealth claims.
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- Medicare beneficiaries: Makes it easier to trace who ordered or supplied durable medical equipment, prosthetics, clinical laboratory tests, diagnostic imaging, and home health services. Encounter data that lack a valid, active provider NPI must be rejected.
- Excluded providers: Requires CMS to deactivate NPIs for entities excluded from federal health programs. Deactivation begins on the date of exclusion and ends when the exclusion ends, and NPIs may be reactivated after exclusion terminates.
- Telehealth clinicians and companies: Conditions payment for telehealth services furnished by clinicians employed or contracted by telehealth companies on use of a CMS claims modifier. The Secretary must establish that modifier within 180 days.
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Bill Overview
Analyzed Economic Effects
2 provisions identified: 1 benefits, 0 costs, 1 mixed.
Deactivate provider IDs for excluded providers
If enacted, HHS would have to turn off a provider’s ID number (NPI) when that provider is excluded from any federal health program. Individual providers’ IDs would be shut off on the exclusion date and turned back on when the exclusion ends. Organization IDs would be turned off only if the Inspector General asks and HHS agrees. IDs could not be deactivated if HHS has waived the exclusion for a program. HHS would update rules within 180 days and check the exclusion list against active IDs within one year and then every year.
Stricter Medicare IDs and telehealth billing
If enacted, Medicare Advantage plans would have to include the ordering or referring clinician’s NPI on encounter records for certain services, like durable medical equipment, lab tests, imaging, and some home health. HHS could reject records that miss this ID or use an inactive or invalid one. For Medicare telehealth, claims from clinicians employed by or contracted with telehealth‑only companies would need a new claims modifier; without it, Medicare would not pay. HHS would create this modifier within 180 days. These steps could improve fraud checks but may cause claim rejections or payment delays if data are missing.
Sponsors & CoSponsors
Sponsor
Doggett
TX • D
Cosponsors
There are no cosponsors for this bill.
Roll Call Votes
No roll call votes available for this bill.
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